Tuberculosis Patients In Malaysia Research Articles

A qualitative exploration of tuberculosis patients who were lost to follow-up in Malaysia.

Loss to follow-up (LTFU) is an unsuccessful treatment outcome for tuberculosis (TB) patients. In Malaysia, LTFU affects around 1 in 20 TB patients. Integration of qualitative research methods and evidence will provide a better understanding of LTFU and its underlying issues. In this study, we qualitatively explored TB patients' experiences in receiving treatment and their reasons for leaving TB care. In-depth interviews of 15 patients with a history of LTFU were conducted from January to September 2020. Interview guides were developed to explore TB patients' experiences while receiving treatment, including challenges faced and reasons for treatment interruption. Data were thematically analysed using the framework method. We identified 11 emerging themes that occurred at four levels of interaction with TB patients. First, at the patient personal level, TB beliefs referring to patients' perception of illness and wellness, patients' perceived role of traditional and complementary medicine, and substance abuse were important. Second, the healthcare system and treatment factors that were highlighted included the organisation of care and treatment, interaction with healthcare professionals, particularly in communication and counselling, and TB medications' side effects. Third, structural factors including financial burden, logistical and transportation issues and work-related factors were identified to be barriers to treatment continuation. Fourth, the interpersonal level interaction of patients should not be neglected; this includes family relationships and support as well as peer influence. Study findings put forth issues and challenges faced by TB patients while receiving treatment and underscore areas where actions can be taken. This will contribute to informing the development and implementation of future TB control strategies that are responsive to TB patients' needs and concerns, to effectively address LTFU and ensure better treatment completion rates among TB patients in Malaysia.

Optimized support vector regression predicting treatment duration among tuberculosis patients in Malaysia

Optimized support vector regression predicting treatment duration among tuberculosis patients in Malaysia

Determinants of delayed tuberculosis treatment among patients in Selangor: A study protocol.

The high prevalence rate and ever-increasing incidence of tuberculosis (TB) worldwide remain a significant issue in healthcare. In Malaysia, the incidence and mortality rate of TB is increasing due to the delayed presentation of TB patients to healthcare facilities. However, there is a lack of local studies on the contributing factors of delayed presentation of TB patients in Malaysia. This study aims to establish a social epidemiology framework by analysing social factors including socio-epidemiological, socio-cultural, and health-seeking behaviours associated with the delay in seeking TB treatment among patients in Selangor, Malaysia. A sequential exploratory mixed-method study design that combines qualitative and quantitative research methods will be employed. This study will recruit adult patients who have been diagnosed with TB using chest X-ray and sputum smear microscopy. Four districts with the highest recorded cases in the state of Selangor will be selected as study locations. The qualitative study will involve a Focus Group Discussion (FGD) to explore six components, namely demographic, socio-cultural, health-seeking behaviours, social support and resources, previous knowledge and experience with illness, and treatment pathway. Meanwhile, the quantitative study will incorporate a structured survey that will be developed based on the themes identified in the qualitative phase and a review of several studies in the literature. Several quality control measures will be taken while ensuring that the survey questionnaires are anonymised and participants’ confidentiality is maintained. The data obtained from both qualitative and quantitative approaches will be combined to provide a more robust assessment of the study. Given that this study will focus on districts with high recorded cases of TB in Selangor, the findings might assist to address TB-related issues such as the increasing incidence and mortality rates, which are mainly attributed to the delayed presentation of TB patients to healthcare facilities.

Factors of Video Directly Observed Therapy Adoption in Malaysia

Remote patient monitoring using mobile devices can be a cost-effective, time-saving solution limiting patient mobility. Direct observation of therapy (DOT) of tuberculosis patients in Malaysia usually involves traveling to the healthcare facility. Due to the contagious nature of the disease, who comes into contact with patients is at risk of developing it. Additionally, DOT is time–consuming and costly for patients. A smartphone application for remote tuberculosis patient monitoring called video directly observed therapy (VDOT) can be a cost-effective and safer way of patient monitoring. However, before implementing this technology, the user readiness assessment helps policymakers' decision-making. This pre-implementation phase study aims to ascertain users' intent to utilize the VDOT app. The current study examines users' readiness using a modified Unified Theory of Acceptance and Use of Technology (UTAUT). The cross-sectional survey took place in Selangor and the federal territory of Kuala Lumpur, Malaysia. A total of 220 questionnaires were delivered to prospective users, including patients and family members. 68% percent of the questioners were deemed usable and were evaluated using SPSS. The study's findings indicate that users intend to adopt the VDOT app for tuberculosis remote monitoring. Performance expectancy, social influence, facilitating conditions, and trust influence users' behavioral intention to adopt the VDOT app in Malaysia.

Effect of smoking on treatment outcome among tuberculosis patients in Malaysia; a multicenter study

BackgroundSmoking plays a key role in the development of tuberculosis (TB) infection and is also a predictor of poor TB treatment prognosis and outcomes. The current study was conducted to determine the prevalence of smoking and to assess the effects of smoking on treatment outcomes among TB patients.MethodsA multi-center retrospective study design was used to collect data from TB patients in four different states of Malaysia, namely Penang, Sabah, Sarawak, and Selangor. The study included medical records of TB patients admitted to the selected hospitals in the period from January 2006 to March 2009. Medical records with incomplete data were not included. Patient demographics and clinical data were collected using a validated data collection form.ResultsOf all patients with TB (9337), the prevalence of smokers was 4313 (46.2%). Among smokers, 3584 (83.1%) were associated with pulmonary TB, while 729 (16.9%) were associated with extrapulmonary TB. Male gender (OR = 1.43, 95% CI 1.30–1.58), Chinese ethnicity (OR = 1.23, 95% CI 1.02–1.49), Sarawak indigenous ethnicity (OR = 0.74, 95% CI 0.58–0.95), urban residents (OR = 1.46, 95% CI 1.33–1.61), employed individuals (OR = 1.21, 95% CI 1.09–1.34), alcoholics (OR = 4.91, 95% CI 4.04–5.96), drug abusers (OR = 7.43, 95% CI 5.70–9.60) and presence of co-morbid condition (OR = 1.27, 95% CI 1.16–1.40) all showed significant association with smoking habits. This study found that 3236 (75.0%) patients were successfully treated in the smokers’ group, while 4004 (79.7%) patients were non-smokers. The proportion of deaths (6.6%, n = 283), defaulters (6.6%, n = 284) and treatment interruptions (4.7%, n = 204) was higher in the smokers’ group.ConclusionsSmoking has a strong influence on TB and is a major barrier towards treatment success (OR = 0.76, 95% CI 0.69–0.84, p < 0.001). Therefore, the findings indicate that smoking cessations are an effective way to decrease treatment failure and drug resistance.

Prevalence of Depression and Associated Factors among Tuberculosis Patients in Primary Care in the District of Kuching, Sarawak

Depression in tuberculosis (TB) increases the risks of adverse health outcomes. However, little is known about depression in tuberculosis patients in Malaysia. The aim of this study was to determine the prevalence and associated factors of depression in tuberculosis patients in primary care clinics. A cross-sectional study was adapted for this study. A total of 235 TB patients were recruited in six primary care clinics in the district of Kuching, Sarawak in Malaysia using convenience sampling method. A self-administered questionnaire, Patient Health Questionnaire-9 (PHQ-9), was used to screen for depression, and social support was accessed using Multidimensional Scale of Perceived Social Support, MSPSS. This study showed that the prevalence of depression among TB patients was 7.7%. Socio-demographic factors, tuberculosis-related clinical data and social support are not significantly associated with participant’s depressive states. Findings also showed that there is no different in terms of social support received by depressive and non-depressive tuberculosis patients. Conclusively, depression in TB patients is considered low; however, screening for depression in TB patients should not be neglected because it can lead to better treatment outcomes.

Determinants of unsuccessful treatment outcomes and mortality among tuberculosis patients in Malaysia: A registry-based cohort study.

IntroductionThe monitoring of tuberculosis (TB) treatment outcomes and examination of the factors affecting these outcomes are important for evaluation and feedback of the national TB control program. This study aims to assess the TB treatment outcomes among patients registered in the national TB surveillance database in Malaysia from 2014 until 2017 and identify factors associated with unsuccessful treatment outcomes and all-cause mortality.Materials and methodsUsing registry-based secondary data, a retrospective cohort study was conducted. TB patients’ sociodemographic characteristics, clinical disease data and treatment outcomes at one-year surveillance were extracted from the database and analyzed. Logistic regression analysis was used to determine factors associated with unsuccessful treatment outcomes and all-cause mortality.ResultsA total of 97,505 TB cases (64.3% males) were included in this study. TB treatment success (cases categorized as cured and completed treatment) was observed in 80.7% of the patients. Among the 19.3% patients with unsuccessful treatment outcomes, 10.2% died, 5.3% were lost to follow-up, 3.6% had outcomes not evaluated while the remaining failed treatment. Unsuccessful TB treatment outcomes were found to be associated with older age, males, foreign nationality, urban dwellers, lower education levels, passive detection of TB cases, absence of bacille Calmette-Guerin (BCG) scar, underlying diabetes mellitus, smoking, extrapulmonary TB, history of previous TB treatment, advanced chest radiography findings and human immunodeficiency virus (HIV) infection. Factors found associated with all-cause mortality were similar except for nationality (higher among Malaysians) and place of residence (higher among rural dwellers), while smoking and history of previous TB treatment were not found to be associated with all-cause mortality.ConclusionsThis study identified various sociodemographic characteristics and TB disease-related variables which were associated with unsuccessful TB treatment outcomes and mortality; these can be used to guide measures for risk assessment and stratification of TB patients in future.

The mortality predictive model for tuberculosis patients in Malaysia: an application of surveillance data 2013–2014

Purpose: Mortality due to tuberculosis (TB) remained a challenge in Malaysia. Its mortality burden has been persistent and the highest among all notifiable infectious diseases for the last thirty years. We made use of the nationwide TB surveillance data to develop a mortality predictive model for TB patients managed in Malaysia. Methods & Materials: A content analytic exercise was conducted by using a two-year notification data in 2013 and 2014. The dataset was processed and the characteristics of mortality were explored. Results: Out of 48,780 notified TB cases, there was 6.01% mortality cases whereby 32.82% (n = 931) had died directly due to TB. The mean age was 50.84 (SD = 18.67) years old, male (69.1%), Malaysian (88.5%), Malay (46.5%), with low education (95.1%) and without permanent income (65%), non-diabetic (81.5%), non-smoker (62.9%) and without HIV co-infection (88.1%). The majority of cases were new cases (90.9%), pulmonary smear positive (70.7%) and with BCG scars (71.4%) who died during the first two months of intensive treatment phase (87.8%). Further analysis revealed that age, late presentation, pulmonary severity, presence of secondary infection and meningitis were significant predictors of mortality for TB patients in Malaysia [p < 0.05]. The risk of mortality significantly increased with late presentation, worsening of pulmonary severity, presence of meningitis and secondary infection respectively [Adjusted OR 95%CI: 16.078% (11.796%-21.913%); 2.022% (1.682%-2.431%); 1.634% (1.101%-2.426%); 1.46% (1.182%-1.792%) respectively]. Age was also found to be a significant predictor, however, at a small and low risk of 2.4% with increase in age [Adjusted OR 95%CI: 0.986% (0.981%-0.991%)]. Conclusion: This is a significant TB mortality model that represented TB patients managed in Malaysia with strong predictive probability [95%CI: ROC AUC 73.6% (71.5%; 75.7%); Hosmer and Lemeshow chi-squared = 7.313 (p > 0.503)]. Further work on risk scoring and characterization of TB mortality is warranted to develop a predictive mortality checklist tool for early and targeted interventions. Further analyses on mortality according to high risk subpopulations such as TB-diabetes, TB-elderly and TB-healthcare workers are also highly recommended for in-depth understanding to formulate and implement subpopulation-targeted interventions.

Faktor Penghalang dan Penggalak Kepatuhan daripada Perspektif Pesakit Tuberkulosis Cicir Rawatan di Kuala Lumpur

There is a large volume of published studies describing the adverse relationship between treatment non-adherence with tuberculosis treatment outcome. Non-adherence could result in increased risks of prolonged infectiousness, drug resistance, relapse cases and poor survival among tuberculosis patients. Nevertheless, few studies are to be found providing detailed on the reason of defaulting treatment among tuberculosis patients in Malaysia. Hence the goal of this paper is to find out the barriers and motivations factors that affect patients’ treatment compliance among our local tuberculosis patients. This is a qualitative study which included 12 in-depth interviews with tuberculosis non-compliance patients who were treated at Institute of Respiratory Medicine, Kuala Lumpur. All the conversations were recorded, transcribed and analysed by using thematic analysis. It was found that low knowledge, self-negative attitudes, traditional believes, negative perceptions towards health caregiver, drug side effects, stigma, financial problems, less family support and work commitments are the barriers that prevent the patients from religiously taking their anti-tuberculosis treatment. Meanwhile, factors that encourage them to continue their treatment were the believes of bad effects of the disease onto their lives and health, good relationship between patient and health caregiver and social support from people around them. In conclusion, non-adherence involved a dynamic influence of individual, socio-economic and treatment-related factors on the patients. The results presented here may facilitate improvement in the activities in promoting compliance among tuberculosis patients in the future which tailored to the patients’ specific needs. DOI : http://dx.doi.org/10.17576/JSKM-2017-1501-10

Development and validation of a questionnaire on the knowledge of tuberculosis and the perception of tuberculosis treatment among tuberculosis patients in Malaysia

Background: A high level of awareness on tuberculosis (TB) is crucial for the success of the prevention and treatment among the high risk populations. Having a good perception about the treatment of TB may increase the acceptance of the control measures in decreasing the spread of the disease. Aims & Objective: To develop and validate a Questionnaire about the knowledge of the causes, mode of transmission, the prevention of TB and the perception of TB treatment among TB patients in Malaysia. Materials and Methods: A Cross-sectional study was conducted among TB patients attended the Respiratory Clinic at the Hospital Raja Perempuan Zainab II, Kelantan, Malaysia. This study used a self-administrated questionnaire that takes approximately 10 minutes to complete and was generally well received by the respondent’s. The validation involved content validity, exploratory factor analysis for the construct validity and internal consistency for reliability. Results: A total of seventy TB patients comprising of 39 males (55.7%) and 31 females (44.3%) responded. The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) was (0.827 and 0.723) and Bartlett\'s test of Sphericity was highly significant (P

Erratum to: SF-36v2 norms and its’ discriminative properties among healthy households of tuberculosis patients in Malaysia

Erratum to: SF-36v2 norms and its’ discriminative properties among healthy households of tuberculosis patients in Malaysia

SF-36v2 norms and its’ discriminative properties among healthy households of tuberculosis patients in Malaysia

The aim of the study was to obtain norms of the SF-36v2 health survey and the association of summary component scores with socio-demographic variables in healthy households of tuberculosis (TB) patients. All household members (18 years and above; healthy; literate) of registered tuberculosis patients who came for contact tracing during March 2010 to February 2011 at the respiratory clinic of Penang General Hospital were invited to complete the SF-36v2 health survey using the official translation of the questionnaire in Malay, Mandarin, Tamil and English. Scoring of the questionnaire was done using Quality Metric's QM Certified Scoring Software version 4. Multivariate analysis was conducted to uncover the predictors of physical and mental health. A total of 649 eligible respondents were approached, while 525 agreed to participate in the study (response rate = 80.1 %). Out of consenting respondents, 46.5 % were male and only 5.3 % were over 75 years. Internal consistencies met the minimum criteria (α > 0.7). Reliability coefficients of the scales were always less than their own reliability coefficients. Mean physical component summary scale scores were equivalent to United States general population norms. However, there was a difference of more than three norm-based scoring points for mean mental component summary scores indicating poor mental health. A notable proportion of the respondents was at the risk of depression. Respondents aged 75 years and above (p = 0.001; OR 32.847), widow (p = 0.013; OR 2.599) and postgraduates (p < 0.001; OR 7.865) were predictors of poor physical health while unemployment (p = 0.033; OR 1.721) was the only predictor of poor mental health. The SF-36v2 is a valid instrument to assess HRQoL among the households of TB patients. Study findings indicate the existence of poor mental health and risk of depression among family caregivers of TB patients. We therefore recommend that caregivers of TB patients to be offered intensive support and special attention to cope with these emotional problems.

Tracing contacts of TB patients in Malaysia: costs and practicality.

Tuberculin skin testing (TST) and chest X-ray are the conventional methods used for tracing suspected tuberculosis (TB) patients. The purpose of the study was to calculate the cost incurred by Penang General Hospital on performing one contact tracing procedure using an activity based costing approach. Contact tracing records (including the demographic profile of contacts and outcome of the contact tracing procedure) from March 2010 until February 2011 were retrospectively obtained from the TB contact tracing record book. The human resource cost was calculated by multiplying the mean time spent (in minutes) by employees doing a specific activity by their per-minute salaries. The costs of consumables, Purified Protein Derivative vials and clinical equipment were obtained from the procurement section of the Pharmacy and Radiology Departments. The cost of the building was calculated by multiplying the area of space used by the facility with the unit cost of the public building department. Straight-line deprecation with a discount rate of 3% was assumed for the calculation of equivalent annual costs for the building and machines. Out of 1024 contact tracing procedures, TST was positive (≥10 mm) in 38 suspects. However, chemoprophylaxis was started in none. Yield of contact tracing (active tuberculosis) was as low as 0.5%. The total unit cost of chest X-ray and TST was MYR 9.23 (2.90 USD) & MYR 11.80 (USD 3.70), respectively. The total cost incurred on a single contact tracing procedure was MYR 21.03 (USD 6.60). Our findings suggest that the yield of contact tracing was very low which may be attributed to an inappropriate prioritization process. TST may be replaced with more accurate and specific methods (interferon gamma release assay) in highly prioritized contacts; or TST-positive contacts should be administered 6H therapy (provided that the chest radiography excludes TB) in accordance with standard protocols. The unit cost of contact tracing can be significantly reduced if radiological examination is done only in TST or IRGA positive contacts.

Outcomes of tuberculosis treatment: a retrospective cohort analysis of smoking versus non-smoking patients in Penang, Malaysia

The association between tobacco smoking and tuberculosis (TB) is increasingly coming to light and the literature is laden with the evidence of this association. However, only a few observational studies specifically investigated the association between smoking and TB treatment outcomes. The present study aims to determine the prevalence of smoking among TB patients in Penang and to compare the treatment outcomes between smoking and non-smoking TB patients. A retrospective estimate of smoking prevalence among patients with TB and a retrospective cohort study comparing smoking and non-smoking TB patients with regards to treatment outcomes was conducted. The data were extracted from medical records of newly diagnosed TB patients who registered at a chest clinic at a tertiary care hospital in the state of Penang, Malaysia from January 2006 to June 2008. The prevalence of ever-smoking among TB patients was 53.4%. Smoking was significantly associated with male gender, alcohol use, and intravenous drug use (IVDU). Ever smokers had increased likelihood of treatment failure (OR 7.48), default (OR 7.17) and were less likely to be cured (OR 0.34). After controlling for the effects of confounders using multivariate logistic regression, ever smokers were still less likely to be cured (aOR 0.31) and more likely to default treatment (aOR 3.24). Dying from TB did not reach statistical significance. Prevalence of smoking was high among TB patients in Malaysia. This study further reaffirms that smoking is an independent predictor of poor TB treatment outcomes and prognosis.